Active NPI
Jennifer Jo Boone, PA-C
- Physician Assistant
- Indianapolis, IN
National Provider Identifier
1518102201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9104712
- Practice address
- 6040 W 84TH St
Indianapolis, IN 46278-1360 - Phone
- (317) 956-6288
- NPI assigned
- Dec 9, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9104712 | FL | Primary |
Addresses
Primary practice location
6040 W 84TH St
Indianapolis, IN 46278-1360
Mailing address
909 N Grant St
Lebanon, IN 46052-1942
Phone (260) 726-5656
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363219200000",
"number": "1518102201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "909 N GRANT ST",
"city": "LEBANON",
"state": "IN",
"postal_code": "460521942",
"telephone_number": "260-726-5656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6040 W 84TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462781360",
"telephone_number": "317-956-6288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOONE",
"first_name": "JENNIFER",
"middle_name": "JO",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-09",
"last_updated": "2013-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9104712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.